HomeMy WebLinkAboutSewageSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[✓] New System j ] Existing System
[ ] Repair [ ] Abandonment
PERMIT NO. 5F -2-ci
DATE PAID:)-�
FEE PAID: ,Da7
RECEIPT #: CIC- 1001
[ ] Holding Tank [ ] Innovative
I ] Temporary [ ]
APPLICANT: RA CONSTRUCTION CORP PF THE TC/HOMES BYA ABURTON
AGENT: RICHARD ADAMS III TELEPHONE: 772.260.8419
MAILING ADDRESS: 2145 Ne Ocapi Court Jensen Beach Florida 34957
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT: A & B BLOCK: 2 SUBDIVISION: Queens Cove unit 1 PLATTED: BkI I P 12
PROPERTY ID #: 1414-701-0013-000-0 ZONING: RS-4 I/M OR EQUIVALENT: [ No M ]
PROPERTY SIZE: .34 ACRES WATER SUPPLY: [ ✓] PRIVATE PUBLIC [L/]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ED ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 51 sovereign way
DIRECTIONS TO PROPERTY: ALA North to Queens cove Left on Sovereign Way property corner lot at Soveriegns way and
Queen Guinevere
BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Soft Table 1, Chapter 64E-6, PAC
1 single family 4 2835
2
3
4
[ ] Floor/Eqyipment Drains [ Other (Specify)
C
SIGNATURE: ` DATE: �" Z
DR 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
MUH
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: #: 56-SF-2141736 BILL ooc #.56-BID-4927974 CONSTRUCTION APPLICATION #. AP1554640
RECEIVED FROM: Richard Adams III AMOUNT PAID: $ 545.00
PAYMENT FORM: CHECK 1001 PAYMENT DATE: 08/27/2020
MAIL TO: (RA Construction Corp FG the TC/Homes By A Burton)
FACILITY NAME:
PROPERTY LOCATION:
51 Sovereign Way
Fort Pierce, FL 34949
Lot: AN
Property ID: 1414-401-0013-000-0
Block: 2
EXPLANATION or DESCRIPTION:
QUANTITY
FEE
128 - OSTDS Construction System Inspection Research Fee
1
$
5.00
-1 - Surcharge (Ail)
1
$
45.00
-1 - OSTDS New Permit Surcharge
1
$
100.00
-1 - OSTDS Construction Application and Plan Review,New
1
$
100.00
123 - OSTDS Construction Site Evaluation
1
$
115.00
126 - OSTDS Construction Permit (New or Mod, Amendment)
1
$
55.00
127 - OSTDS Construction System Inspection
1
$
75.00
133 - OSTDS Construction Reinspection
1
$
50.00
RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-4591276
.J
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN A 02, Tallahassee, Florida 32399. The Agency
Clerk's facsimile number is 850-413-8743.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order will
constitute a waiver of your right to an administrative hearing, and this order shall become a 'final
order.
Should this order become a final order, a party who is adversely affected by it is entitled
to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a
second copy, accompanied by the filing fees required by law, with the Court of Appeal in the
appropriate District Court. The notice must be filed within 30 days of rendition of the final order.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
PERMIT #:66-SF-2141736
APPLICATION #:AP1554640
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1408379
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: _(RA Construction Corp FG the TC/Homes By A Burton)
PROPERTY ADDRESS: 51 Sovereign Way Fort Pierce, FL 34949
LOT: A&B BLOCK: 2 SUBDIVISION: Queens Cove
PROPERTY ID #: 1414401-0013-000-0 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NOMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 1,050 ] GALLONS / GPD Septic new CAPACITY
A [ ] GALLONS / GPD N/A _ CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K I ] GALLONS DOSING TANK CAPACITY [ . ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 667 ] SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED DC] FUND [ I
I CONFIGURATION: [ ] TRENCH [X] BED ( ]
N
F LOCATION OF BENCHMARK. nail in cut-out, CL of intersection
I ELEVATION OF PROPOSED SYSTEM SITE [ 4.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO HE [ 6.00 3[ INCHES FT ][ A80VE BELOW]BENCHMARK/REFERENCE POINT
L
D
O
T
H
E
R
AWWUj;=D: j zu.uU] INCHES EXCAVATION REQUIRED: [ 4200 ] INCHES
system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
gpd.
a.
SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental 9 ` peoialist II
APPROVED BY: TITLE: Environmental Specialist II St, Lucie CHD
Brian J I am
DATE ISSUED: 09/16/2020 EXPIRATION DATE: 03/16/2022
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1554640 SE1366912
f }
APPLICATION # p1 54640
a 58-SF 2141736_
LOT: ID; �d14-401 OQ13-1111111111
000=0 gNGINEERB MUST PROVIDE
Queens Cove OTHER— QUALIFIED PERSON.
SUMMSION: gMPT,OYEE,ITEMS
BY ENGINEER, HEALTH DEPARTMENT C0'E, ALL ACRES
BE CANPLETED SEAL EACH PAGE 08 SUBMITTAL. A A�gILABI,E: 034
REGISTRATION NUMBER A� SIGN AND NET USABLE ARE
[X]YES L ]NO RESIDENCES-TABLEI / OTHER -TABLE 2 ]
SIZE CONFORMS TO SITE PT�°'N' I
PROPERTY 400 GALLONS PER DAY 1500 GPD/ACRE OR 2500 GPD/ACRE 7
TOTAL ESTIMATED S '� A GALLONS PER DAY � 1000.00 3QFT
849.98 gEDUIRED:
AUTHORIZED SEWAGE FLOW: i000.00 SOFT UNOBSTRUCTED AREA
UNOBSTRUCTED AREA AVAILABLE:
�'�'
nail in cut-out, CL of �rl�tAIBOVE
POINT
CE POINT LOCATION: / ��=7�/rMXFZRZKCE
BENCHN /REFEREN t),00 t INCHESmm
ELEVATION OF PROPOSED SYSTEM SITE ��--- G FEATURES
g NO
NOD FROM THE PROPOSED SYSTEM TO THE NOBLY WET: t ]YES ] FT
THE MMIUM MSETBACM WHICH CAN DITCHES/SVPZMg' -^F9 FT NON -POTABLE:
WATER: 50,FT FT � :�— POTABLE WATER LINES. --�—FT
SURFACE FT LINES: USE: `„�., 5 FT
WELLS: PUBLIC- ---.-- FT PROPERTY LINES X N
BUILDING FOUNDATIONS : FLOODING? L ]S [ ] OJ
10 YEAR NGVD
1 ]YES [X ]NO FT [ MSL /
FREQUEZJT FLOODING? FT I MSL / NGVD 1 SITE ELEVATION:
SITE SUBJECT 'go SITE: RMATION SITE 2
10 YEAR
FLOOD EJ,EVp,TION FOR SOIL PROFILE INFO
TION SITE 1 USDA SOIL SERIES: Texture Depth
soil PROFILE Munsell #!Color 0 To 9
UA SOIL' SERIES. Organic
SDDept 10YR 312 Sail
Texture Loamy Fine Sand 9 To 25
Munsell #]Color Organic Sdil O To 9 10YR 412 15 To 23
10YR 312 9 To 25 CMNIPRM RF
Fine Sand 10YR 518 Clay Loam 25 To 42
10YR 4!2 �MNIPRM RF 14 To 22 Sandy Y
25 To 39 10YR 612 Fine Sand 42 To 47
10YR 518 Sandy Clay Loam 10YR 511
10YR 612 39 To 46 VF Sand 47 To 63
Sand 10YR 4I1 63 To 72
10YR 511 VF Sand 46 To 63 Refusal
10YR 511 Refusal 63To 72 HOLE CAVING
HOLE CAVING
E TYPE: I PERCHED / APPARENT
BELOW ] EXISTING GRAD BELOW ] EXISTING GRADE
22.00 INCHES [ ABOVE / INCHES [ ABOVE /� INCHE
OBSERVED WATER TABLE: -- NO DEPTH: ram.
TABLE ELEVATION: MOTTLING: tX ]YES L ]
ESTIMATED WET SEASON WATER[ jYEB [X ]NO ILJCFT
R TABLE VEGETATION:SandlO.60 DEPTH OF EXCAVATION: 4�2..
HIGH WATER
/LOADING RATE FOR SYSTEM SIZING: X ] BED E OTHER (SPECIFY)
SOIL 'RT ] TRENCH
DRAINFIELD CONFIGURATION:
LWSWMT
MS/ADDITIONAL CRITERIA
determined usingUSDAWS r412 matrix 2% startingat 14" in sb1.
amn promrfmottling in 10y DATE; 09/1112020
d S82 4"above BM.
NVIRONpfiENTAL 61EAV14) Page 3 of
SITE EVALUp,TED BY: e, Envi
ronmental SPeatatlatll) IF 643-6.001, PAC
Ingram, Bd Iacozporated:
ioue editio whioh may not be used)
DH 4015, 08/09 (obsolete" p AP1664640 EID2141736
STATE OF FLORIDA APPLICATION # AP1554640
DEPARTMENT OF HEALTH
PERMIT # 56-SF-2141736
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1366911
APPLICANT: RA Construction Corp FG the TC/Homes By A Burton
CONTRACTOR / AGENT: Richard Adams III
LOT: A&B BLOCK: 2
SUBDIVISION: Queens Cove ID#: 1414-401-0013-000-0
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE.
REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.34 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 849.98 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: nail in cut-o
ELEVATION OF PROPOSED SYSTEM SITE 4.00 [
CL of intersection
/ FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 50 FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES EX ]NO 10 YEAR FLOODING? [ ]YES [XINO]
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
SOTT, PROPTT.F. TWMRMATTON STTF. 1 C0TT. DRAFTT.P. TNF(1RMATTnV RTTF. 9
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
10YR 3/2
Organic Soil
0 To 9
1OYR 4/2
Fine Sand
9 To 25
1 OYR 5/8
CMN/PRM RF
14 To 22
1 OYR 6/2
Sandy Clay Loam
25 To 39
1 OYR 5/1
Sand
39 To 46
1 OYR 5/1
VF Sand
46 To 63
HOLE CAVING
Refusal
63 To 72
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
10YR 3/2
Organic Soil
0 To 9
10YR 4/2
Loamy Fine Sand
9 To 25
10YR 5/8
CMN/PRM RF
15 To 23
10YR 6/2
Sandy Clay Loam
25 To 42
10YR 5/1
Fine Sand
42 To 47
1 OYR 4/1
VF Sand
47 To 63
HOLE CAVING
Refusal
63 To 72
OBSERVED WATER TABLE: 22.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 14 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: 42 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED, [ ] OTHER (SPECIFY)
[- REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings.
10yr5/8 cmn prom rf mottling In 10yr4/2 matrix >2% starting at 14" in sb1.
SB1 and S132 4" above BM. „ n
SITE EVALUATED BY:
Ingram, Brl (Title: Environmental Specialist II) (ENVIRONMENTAL HEALTH)
DH 4015, 08/09 (Obsoletes previous edition which may not be used) Incorporated: 64E-6.001, FAC
AP1554640 EID2141736
DATE: 09/11 /2020
Page 3 of 4
v 1.0.2
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: (RA Construction Corp FG the TC/Homes By A Burton)
PROPERTY ADDRESS: 51 Sovereign Way Fort Pierce, FL 34949
LOT: A&B BLOCK: 2 SUBDIVISION: Queens Cove
PROPERTY ID #: 1414-401-0013-000-0
PERMIT #:56-SF-2141736
APPLICATION # : AP 1554640
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1408379
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 1,050 ] GALLONS / GPD Septic new CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM- CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 667 ] SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X1 MOUND [ ]
I CONFIGURATION: [ ] TRENCH [XI BED []
N
F LOCATION OF BENCHMARK: nail in cut -Out, CL of intersection
I ELEVATION OF PROPOSED SYSTEM SITE [ 4.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 6.00 ][ INCHES FT ][ABOVE BELOW]BENCHMARK/REFERENCE POINT
,L
D F
PE
T
H
E
R
REQUIRED: L Zt3.UUJ INCHES EXCAVATION REQUIRED: L 4Z.uu J INUMNS
system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
gpd•
SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist II
APPROVED BY: TITLE: Environmental Specialist II St. Lucie CHD
Brian J 1j&am
DATE ISSUED: 09/16/2020f EXPIRATION DATE: 03/16/2022
DH 4016, 08/09 (Obsoletes all previous editions which may not'be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1554640 SE1366911
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency
Clerk's facsimile number is 850-413-8743.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order will
constitute a waiver of your right to an administrative hearing, and this order shall become a 'final
order'.
Should this order become a final order, a party who is adversely affected by it is entitled
to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a
second copy, accompanied by the filing fees required by law, with the Court of Appeal in the
appropriate District Court. The notice must be filed within 30 days of rendition of the final order.
}
„ r. w.;
.HEALTH
PAYING ON:
RECEIVED FROM:
PAYMENT FORM:
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
#: 56-SF-2141736 BILL DOC #:56-BID-4927974 CONSTRUCTION APPLICATION #: AP1554640
Richard Adams III AMOUNT PAID: $ 545.00
CHECK 1001 PAYMENT DATE: 08/27/2020
MAIL TO: (RA Construction Corp FG the TC/Homes By A Burton)
FACILITY NAME: �UUI . , a Qqo 00 ;�Ch D
PROPERTY LOCATION:
51 Sovereign Way
Fort Pierce, FL 34949
Lot: A&B Block: 2
Property ID: 1414-401-0013-000-0
EXPLANATION or DESCRIPTION:
128 - OSTDS Construction System Inspection Research Fee
-1 - Surcharge (All)
-1 - OSTDS New Permit Surcharge
-1 - OSTDS Construction Application and Plan Review,New
123 - OSTDS Construction Site Evaluation
126 - OSTDS Construction Permit (New or Mod, Amendment)
127 - OSTDS Construction System Inspection
133 - OSTDS Construction Reinspection
QUANTITY
FEE
1
$
5.00
1
$
45.00
1
$
100.00
1
$
100.00
1
$
115.00
1
$
55.00
1
$
75.00
1
$
50.00
RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-4591276
n
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
.� SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[✓] New System [ ] Existing System [ ] Holding Tank
[ ] Repair [ ] Abandonment [ ] Temporary
APPLICANT: RA CONSTRUCTION CORP PF THE TC/HOMES BYA ABURTON
AGENT: RICHARD ADAMS III
MAILING ADDRESS: 2145 Ne Ocapi Court Jensen Beach Florida 34957
PERMIT NO. 5p -2 I q
DATE PAID:
FEE PAID: �cl
RECEIPT #: CY— 1001
[ ] Innovative
TELEPHONE: 772.260.8419
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT: A & B BLOCK: 2 SUBDIVISION: Queens Cove unit 1 PLATTED: BkI I P 12
PROPERTY ID #: 1414-701-0013-000-0 ZONING: RS-4 I/M OR EQUIVALENT: [ No 0 ]
PROPERTY SIZE: .34 ACRES WATER SUPPLY: PRIVATE PUBLIC [t/]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No E] ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 51 sovereign way
DIRECTIONS TO PROPERTY: AIA North to Queens cove Lefton Sovereign Way property corner lot at Soveriegns way and
Oueen Guinevere
BUILDING INFORMATION
Unit Type of
No Establishment
1 single family
2
3
4
[ ✓ ] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
4 2835
[ ] Floor/E%fipment Drains [ �j] Other (Specify,)
SIGNATURE: Y *,( ��
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
DATE: Z U Zcy
Page 1 of 4
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